Healthcare Provider Details

I. General information

NPI: 1235597311
Provider Name (Legal Business Name): BOSSIER COUNCIL ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 BEARKAT DR
BOSSIER CITY LA
71111-4566
US

IV. Provider business mailing address

706 BEARKAT DR
BOSSIER CITY LA
71111-4566
US

V. Phone/Fax

Practice location:
  • Phone: 318-741-8302
  • Fax: 318-741-7490
Mailing address:
  • Phone: 318-741-8302
  • Fax: 318-741-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number04506690N
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: TAMARA CRANE
Title or Position: EXECUTIVE DIRECTOR
Credential: MA,MFA,CDP
Phone: 318-741-8302